Author & Consultant/Trainer in Health, Social Care, and Management

There are many brilliant staff working in Health and Social Care and there are some, for various reasons, who do not do their best. All have a paid Duty of Care. This means they are paid to protect vulnerable people from abuse and poor practices.
I have managed several care homes for adults with learning disabilities over the years and have been supported by great staff. What made them great? The time invested in them.
Since leaving management I run a health and social care consultancy, which includes delivering training and assessing staff performance and during these times I hear and see both good and poor practices. I report back to the manager and give positive feedback on the good practices and advise them on how they can improve any areas of weaknesses.
I see care staff running around trying to answer the call bells, the staff ratio to the amount of older residents is very poor. Previously, the government, Commission Social Care Inspection [CSCI], before it changed to The Care Quality Commission [CQC] used to state the amount of staff required to support x number of residents. Now it is up to the Manager to convince CQC that they’re staffing is adequate.
Care staff in the community tell me how they rush from one client to the next. Sometimes there are two clients booked at the same time-it’s obvious one is going to be upset as the carer will be late. Many have been verbally, and some physically, abused by the clients. Some staff feel supported, some don’t. Many are highly stressed. Some feel that they work in isolation. Many feel pressured to work long hours due to their colleagues being off sick or on annual leave.

And this is similar to what I hear from some nurses. Feeling stressed, working long hours and not being supported.
Some ask my advice on poor practices they have seen, hoping that I will look into it, they are too scared to, for fear of losing their job. Some would rather find another job before expressing their concerns to the manager. There are many care homes that do not have a policy in place to protect staff if they share their concerns [blow the whistle]. The NHS now has ‘Speak Out Safely – protecting staff who raise concerns‘ and social care could do with something similar.
Tonight at 9pm [30th April 2014] Panorama on BBC1 will be showing a documentary on Care and it won’t be nice. How do I know? I have heard the trailers and read the piece in The Guardian*. Will I be watching it? No! Why, you may ask. Because, even the mention of it makes me feel nauseated. Even writing this blog I feel sick, but feel that I must write it.
At the end of this blog there will be a link for you to click on to know what abuse is and how to share your concerns.
We have read and heard a lot on abuse and poor practices. Indeed, most recent, sickening ones-
‘Concerns have been raised by a series of scandals in care homes across the industry. Three staff at Hillcroft nursing home in Slyne-with-Hest, Lancashire, were earlier this year jailed and a fourth given a community sentence for tormenting and abusing elderly residents with dementia. The court heard residents were pelted with bean bags, mocked and bullied on the assumption their condition meant they would not remember the abuse.
One man’s foot was deliberately stamped on and another was nearly tipped out of his wheelchair.’
My own late mother was a victim of poor care, both by care staff in the nursing home and the majority of staff on two wards in a hospital. My mother left me with a mission, it’s a very long mission, but I will do all I can to raise awareness on this subject and how to raise concerns.
In tonight’s Panorama there will be shocking scenes and talk of using CCTV in residents’ rooms to help stop abuse.

The pros and cons of CCTV

Previously relatives have hidden CCTV in residents rooms as they feared their relatives were being abused, and some were caught on CCTV doing horrific things to their vulnerable, and very scared, relatives.

CCTV is in public places including the grounds of hospitals and many care homes but having them in residents rooms can be an invasion of privacy, dignity and respect. Something all staff are taught to respect. And this invasion of privacy, dignity and respect versus the safety of the individual! Again, something all staff are taught!

How will the older person feel knowing there is a camera in their room? And the reason for the camera being there? Will the camera capture when intimate care is being given?

How do the staff feel having the camera there [if they know they are there, and they should be told that they are]? Will it make the staff nervous and perhaps not perform well?

How do the relatives feel, being watched whilst visiting their relative?

All have a right to privacy and all have a right not to be abused.

What will happen to the footage afterwards?

CCTV/Cameras have been used in successfully identifying abusers but would I want it to be standard in every service and every ward? I asked a friend who worked in Safeguarding what she thought and she said, ‘It’s like shutting the barn door after the horse has bolted. If staff were doing their job properly, there would be no need for CCTV.’
And I agree.

We must be PROACTIVE and not REACTIVE!

Staff choose to work in health and social care because they care and they want to do a great job. So what can cause it to go wrong? The answer is, I believe, is quality of leadership, which includes support, supervision, training and development for staff.

What can be done to prevent poor practices and abuse?

Managers must take responsibility and manage and lead their teams
Managers to call in to the workplace on ad hoc basis to observe staff practices.
Managers to be PROACTIVE and do their own compliance checks so they know if they are not meeting the essential standards and not wait for the CQC to come and point it out to them. .
Managers to work a shift of days and a shift of nights to see what the workload and difficulties are and also a way of observing how the staff treat the residents
Managers of care homes and agencies to send a copy of each CQC Inspection Report to the resident’s next of kin so they can see how well [or not] the Home/Service is doing.
Care and nursing staff often tell me they don’t receive regular private 1-1 staff supervision sessions where training needs are identified and concerns are aired and concerns discussed. Indeed, I carried out a Freedom of Information request back last year asking 10 hospitals across the country if they provided private 1-1 staff supervision sessions and 1 hospital said that they did.
Training that meets the staff’s needs [and in supervision the Supervisor checks that the training did meet their need and question what they learnt] and managers monitoring their staff team.
All care homes and hospital wards to have clear, up to date care and support/nursing plans which are completed regularly.
All care homes to have systems in place to protect the employee who shares their concerns.
Celebrate successes, no matter how small.

A national register for all grades of staff to be on and if they do abuse they get taken off the national register and cannot work in care again.
Relatives to pop in ad hoc and not at set times. If you all go at the same time try spreading it out over the week so the individual has different visitors at different times.